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General NPI Number Information
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NPI Number | 1689208340
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Entity Type | Organization
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Legal Business Name | THE WELLNESS COLLECTIVE LLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 1750 KILBOURN ST
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City | ELKHART
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State | IN
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Zip | 46514-1920
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Country | US
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Telephone | 574-320-3792
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 MAYFLOWER PL
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City | GOSHEN
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State | IN
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Zip | 46526-4738
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Country | US
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Telephone | 574-320-3792
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE THOMAS
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Credential | LCSW
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Telephone | 574-320-3792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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